# AppalTRuST Project 1: Population based Cohort study of tobacco use prevalence in Appalachian KY

> **NIH NIH U54** · UNIVERSITY OF KENTUCKY · 2024 · $297,623

## Abstract

ABSTRACT – PROJECT 1
Rural populations, who use tobacco at almost double national rates, have largely been omitted from studies of
the potential impact of tobacco regulations. AppalTRuST’s overarching goal is to investigate the impact of
Federal Drug Administration Center for Tobacco Products (FDA CTP) regulatory changes on tobacco product
use in rural communities and examine variation based on relative rurality. The FDA regulatory policies have an
outsized potential to reduce tobacco-related disparities in rural Appalachia and the rest of rural America, given
the relatively limited disincentives for use in these areas (i.e., few smoke-free laws and low tobacco taxes). The
goal of Project 1 (P1) is to close the rural tobacco disparities knowledge gap by documenting tobacco use
behaviors and related factors over time among Appalachian KY adults (18+ years) to inform current and future
FDA regulations. P1 addresses the Scientific Domain of Behavior and will be guided by the Health Belief Model
(HBM). The HBM provides a framework to evaluate associations of knowledge, attitudes, perceptions, and
external cues with tobacco use behaviors. P1 will use the AppalTRuST Cohort to enroll 2,000 participants
using a longitudinal cohort design that will collect participant data every 6 months for four years. We will recruit
adults 18+ years from two catchment areas comprising 8 Appalachian KY counties; these two areas represent
a range of rurality and will allow us to make not only catchment comparisons between a rural area and peri-
urban one (i.e., partly urbanized rural areas), but also to assess for associations between tobacco use
indicators and relative rurality within each catchment area. In addition, 40 participants from the Cohort per year
will complete key informant interviews to assess opinions about tobacco products and regulations and allow us
to make annual updates to the survey. We will address the following aims: (1) evaluate baseline prevalence
and longitudinal trends in the use of conventional (cigarettes, smokeless tobacco, hookah, cigars/cigarillos,
and pipes) and novel (e-cigarettes, nicotine pouches, heated tobacco products, and very low nicotine [VLN]
cigarettes) tobacco products, including initiation, continuation, switching, cessation, and dual/poly-use among
Appalachian adults, testing for the effect of rurality and controlling for individual- and county-level
demographics; (2) assess changes over time in knowledge, attitudes, and perceptions relative to tobacco
product characteristics (including flavors/menthol and VLN), among Appalachian KY adults, while evaluating
the effect of rurality and controlling for demographics; and (3) explore perceived benefits, risks, and intentions
to use novel tobacco products among current tobacco product users and individuals susceptible to initiating
novel product use, with annual key informant interviews to capture reaction to changes in the product and
regulatory landscape. We will evaluate the ef...

## Key facts

- **NIH application ID:** 10934519
- **Project number:** 5U54DA058256-02
- **Recipient organization:** UNIVERSITY OF KENTUCKY
- **Principal Investigator:** Mary Kay Rayens
- **Activity code:** U54 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $297,623
- **Award type:** 5
- **Project period:** 2023-09-30 → 2028-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10934519

## Citation

> US National Institutes of Health, RePORTER application 10934519, AppalTRuST Project 1: Population based Cohort study of tobacco use prevalence in Appalachian KY (5U54DA058256-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10934519. Licensed CC0.

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